315,000 Pennsylvanians fall into gap between Medicaid, Obamacare

For months, consumer groups have been sounding alarms about a group of Pennsylvanians who earn too much to enroll in Medicaid. At the same time, their income is too low to qualify for discounts on health plans purchased through the Obamacare marketplace.

Now an analysis from the Web site Healthpocket provides insight into the cost of health insurance for people in the so-called “coverage gap.”

Antoinette Kraus, director of the Pennsylvania Health Access Network, said about 315,000 state residents fall in this gap.

Healthpocket calculated what people in the coverage gap would pay if they bought an entry-level bronze health plan through Healthcare.gov.

In Pennsylvania, a 30-year-old man would spend about 13 percent of his income for coverage. A 50-year-old “in the gap” would spend about 21 percent of his income on premiums.

“These are people who make very little income to begin with. They’re people making less than the federal poverty level, which is $11,490,” said head of data and research Kev Coleman.

There’s been lots of concern that people who fall in the coverage gap will forgo insurance because it will be too costly.

Coleman said his report “economically quantifies” that worry.

“In terms of the burden that this represents, it makes it much more concrete,” he said.

For comparison, the federal government generally considers a health plan unaffordable if someone has to spend more than 9.5 percent of income on coverage.

In this region, the problem is unique to Pennsylvania because the Corbett administration decided not to expand Medicaid to certain people with higher incomes.

“All the states around Pennsylvania have decided to move forward,” Kraus said. “Pennsylvania is really the island of the uninsured.”

Gov. Tom Corbett has proposed an alternative to the Medicaid expansion called Healthy PA. It would subsidize people buying insurance from private companies.

A state spokeswoman says talks continue with the federal government to get that plan approved.